The Oral Behavior Checklist

How often do you do each of the following activities, based on the last month? If the frequency of the activity varies, choose
the higher option. Please place a () response for each item and do not skip any items.
Activities During Sleep
1

Clench or grind teeth when asleep, based on any

information you may have

Sleep in a position that puts pressure on the jaw (for

example, on stomach, on the side)

Activities During Waking Hours

3

Grind teeth together during waking hours

Clench teeth together during waking hours

Press, touch, or hold teeth together other than while eating

(that is, contact between upper and lower teeth)

Hold, tighten, or tense muscles without clenching or

bringing teeth together

Hold or jut jaw forward or to the side

Press tongue forcibly against teeth

Place tongue between teeth

10

Bite, chew, or play with your tongue, cheeks or lips

11

Hold jaw in rigid or tense position, such as to brace or

protect the jaw

12

Hold between the teeth or bite objects such as hair, pipe,

pencil, pens, fingers, fingernails, etc

13

Use chewing gum

14

Play musical instrument that involves use of mouth or jaw

(for example, woodwind, brass, string instruments)

15

Lean with your hand on the jaw, such as cupping or resting

the chin in the hand

16

Chew food on one side only

17

Eating between meals (that is, food that requires chewing)

18

Sustained talking (for example, teaching, sales, customer

service)

19

Singing

20

Yawning

21

Hold telephone between your head and shoulders

None of
the time

<1
Night
/Month

1-3
Nights
/Month

1-3
Nights
/Week

4-7
Nights/
Week

None of
the time

A little of
the time

Some of
the time

Most of
the time

All of the
time

Copyright Ohrbach R. Available at http://www.rdc-tmdinternational.org

Version 12May2013. No permission required to reproduce, translate, display, or distribute.